Dr. Vernon Adams & Dr. Sam Samudio - Insurance Benefit Service

HELPFUL INFORMATION REGARDING YOUR DENTAL INSURANCE . . . (Or . . . a FRANK discussion about DENTAL BENEFITS. We urge you to print this page and share it with a friend.) PLEASE PAGE or SCROLL DOWN or CLICK the SPECIFIED LINK FOR ANSWERS to 16 most frequently asked questions about EMPLOYEE BENEFITS!

We never lose sight of the fact that children are our future.

It is our privilege to care for them, and our joint responsibility

to keep them healthy and happy.

Q 1. If I have DENTAL INSURANCE, DOES THIS AFFECT “MY CHILD'S TREATMENT?” click here for answer

Q 2. WILL MY DENTAL COVERAGE DICTATE WHICH DOCTOR TAKES CARE OF MY CHILD? click here for answer

Q 3. WILL YOU ACCEPT MY INSURANCE BENEFITS AS PAYMENT IN FULL? click here for answer

Q 4. My DENTAL INSURANCE TAKES CARE OF THIS DOESN’T IT??
click here for answer

Q 5. How is DENTAL INSURANCE different from OTHER TYPES OF INSURANCE? click here for answer

Q 6. HOW CAN I HELP RECEIVE MY BENEFITS AS SOON AS POSSIBLE?? click here for answer

Q 7. CAN YOUR STAFF TELL ME HOW MUCH MY DENTAL BENEFITS WILL BE?? click here for answer

Q 8. HOW DO CARRIERS GENERALLY DEAL WITH “DEDUCTIBLES”?? click here for answer

Q 9. FILLING OUT FORMS . . . WILL YOUR OFFICE DO THIS FOR OUR FAMILY? click here for answer

Q10. WILL I EVER NEED TO CONTACT MY CARRIER DIRECTLY?
click here for answer

Q 11. HOW WILL I KNOW YOUR STAFF IS SENDING CLAIMS?
click here for answer

Q 12. WILL I EVER RECEIVE A STATEMENT? click here for answer

Q 13. WHY DON’T/WON’T CARRIERS RELEASE THE FEE SCHEDULES THEY US TO ESTABLISH PAYMENT? click here for answer

Q 14. WILL YOU JUST BILL ME AFTER MY INSURANCE PAYS?
click here for answer

Q 15. WHY CAN’T I JUST PAY AN ESTIMATED PERCENTAGE SHARE IF I HAVE INDEMNITY COVERAGE? click here for answer

Q 16. DO YOU HAVE A QUESTION WE HAVE NOT ADDRESSED?
click here for answer

Q 1. If I have DENTAL INSURANCE, DOES THIS AFFECT “MY CHILD'S TREATMENT?”

NOT IN OUR OFFICE . . . Our practice is people oriented, not insurance driven. AT NO TIME will any guideline or limitation your carrier may impose alter our recommendation for your child.- 99% of our parents meet us through the personal referral of a co-worker, school affiliation, friend or physician.

Preferred provider type dental clinics that rely on attracting families by being on a list find it necessary to work within the carrier’s rules and guidelines. Generally, families who seek these types of offices perceive they cannot afford comprehensive, preventive care and occasionally the dentist makes the same assumption. Some people only want “fix it when it hurts or breaks” dentistry. — Please know we believe every medical and dental facility is providing a needed service to a segment of the community that wants that type of care. Actually, any care is generally better than no care . . . FRANKLY, OUR DOCTORS WILL NOT LET AN INSURANCE CARRIERS GUIDELINE CHANGE THE INFORMATION, AND TREATMENT CHOICES THEY BELIEVE ARE IN YOUR BEST INTEREST, or that you may desire. We believe parents deserve complete information, which will allow you to make a comfortable decision about your child’s long-term dental health.
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Q 2. WILL MY DENTAL COVERAGE DICTATE WHAT DOCTOR TAKES CARE OF MY CHILD?

ABSOLUTELY NOT . . . Our services are built on relationships. You will have a personal doctor and a dedicated treatment coordinator. Our Doctors primary reason for practicing together is to give our families the advantage of full time emergency care and co-consultation as your personal doctor feels it will be in your best interest.
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Q 3. WILL YOU ACCEPT MY INSURANCE BENEFITS AS PAYMENT IN FULL?

We would like to take a moment and challenge you to consider . . .Are you are comfortable going to an office where the doctors and staff are mindful of your benefits as they make their recommendations and give you information? We believe the answer is NO. - In our community we meet families who want to keep their children's mouths healthy, avoid expensive and uncomfortable dental problems: and generally want to maintain a beautiful appearing smile. - IF THIS IS YOUR GOAL you will be best served by coming to a private office like ours. Dr. Adams, Dr. Sam and Dr. Liu's only consideration during exam and consultation is what is in the best interest of your child. Your POLICY LIMITATIONS NEVER INFLUENCE ANY INFORMATION THEY GIVE TO PARENTS.

As a courtesy service, we process all private, indemnity insurance claims and instruct the carrier to reimburse you directly. This keeps you in control of your carrier’s activity.

Q 4. My DENTAL INSURANCE TAKES CARE OF THIS DOESN’T IT?

Yes or no . . . depending on the benefits your employer chose to invest in. Dental plans are determined very much like your auto and medical insurance policies. Benefits are designed based on a combination of percentages, fee schedules and deductibles. Experience has proven that every dental plan has some benefit to most children. In other words, you will MOST LIKELY receive some benefit toward dental treatment.

— It is also interesting that dental care is only 4% of the nations total health care. Therefore, in order for insurance companies to sell MEDICAL PLANS (96% of their business) they often TOSS IN A DENTAL PLAN for free or very, very inexpensively. This tells you that your dental benefits will be minimal at best . . . Our teams attitude, regardless of how minimal your benefits may be, is that “we want to submit claims on your behalf so you are reimbursed to the full extent of your plan.” Every little bit helps plus we would much rather you receive the money than let your carrier keep it!!
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Q 5. How is DENTAL INSURANCE different from OTHER TYPES OF INSURANCE?

— Typically insurance means that if something is lost it will be replaced. That is true with medical insurance . . . if you are sick they will pay a percentage toward each of your visits. That is true with auto insurance . . . if your car is stolen, they will provide benefits toward the purchase of another car. DENTAL BENEFITS ARE DIFFERENT . . . regardless of your conditions, carriers put a limit on how much they will contribute during a time period. Generally this amount is 1,000. WE THINK IT’S INTERESTING THAT DENTAL BENEFITS STARTED OVER 30 YEARS AGO . . . and the maximum, with rare exception, has not changed. Unfortunately this often encourages patients with infections, decay, fractures and broken teeth to consider delaying care. (Could it be that insurance companies want to encourage delayed care?? Hmmm?)

Our goal is to help you with various FINANCIAL SUPPORT OPTIONS (click for link) so you receive timely care when your child's conditions are as minimal as possible. We know that DELAYING CARE is never in your best interest. - We also know that you don’t see what we see. When conditions advance there is always extra expense and most importantly, often painful situations which, with prevention and early detection absolutely can be avoided. This is why everyone on our team is trained to provide supportive information about your child's conditions. We believe the more parents know, the better care they will take of their children.
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Q 6. HOW CAN I HELP RECEIVE MY BENEFITS AS SOON AS POSSIBLE? - Simply make sure you provide complete information to our ADMINISTRATIVE STAFF.

We know you are busy but . . . Please take a moment to make sure we have correct carrier information. Our administrative staff will also make an effort to ask when you bring your children in for continuing care. - When businesses change carriers, it's easy to forget . . . As parents of young children, we know you are busy. This results in us electronically submitting your family’s claims to the cancelled carrier. If this happens, we kindly request you clear your balance before we resubmit to your new carrier. Or, we can provide you with a copy of the new claim and you can submit it yourself.
If your child is over 18 and covered under STUDENT STATUS your carrier requires current school information. We are happy to provide the carrier with any information you give us on the day of treatment.
As we are not set up for extended billing, if your carrier does not receive needed information and we receive a request for additional or missing information, we will mail you a copy of the claim with a copy of the carriers’ request and kindly ask that you pursue your benefits directly.

Q 7. CAN YOUR STAFF TELL ME HOW MUCH MY DENTAL BENEFITS WILL BE?? We wish we could. We know that would be very helpful in allowing all of our families to manage their personal budget!

Unfortunately, due to unlimited policy guidelines and the carriers right to use any fee schedule they chose, the best our staff can do is give you an estimate. For your convenience we are comfortable providing the following information:

If you can obtain a copy of your carriers PERSONAL FEE SCHEDULE you can then determine the amount based on your benefits and the percent allowed toward that procedure.
Preventive procedures (continuing care hygiene visits, preventive exams, and cavity checking x-rays) are generally paid at 100/90/80/50 percent if your carriers fee schedule, not the dentists fees.
Preventive procedure percentages are sometimes paid before the carrier subtracts your annual deductible.
Some carriers do not pay for modern preventive procedures such as sealants or certain bonded procedures.

FYI - Sealants prevent cavities and help children retain baby teeth until they shed them, or permanent first molars that come in by age 5/7 and are the teeth used to chew food for the rest of their life. Our doctors place great importance on protecting these teeth!

Bonded procedures adhere to the remaining healthy tooth structure thereby allowing us to retain maximum tooth structure. (The old type of silver fillings needed to have undercuts drilled inside the tooth once all the unhealthy areas were removed. As you are probably aware, some people are sensitive to toxic metals and mercury used in old fashion silver fillings.)

Unfortunately, anything carriers define as COSMETIC is generally not a covered benefit.

Q 8. HOW DO CARRIERS GENERALLY DEAL WITH “DEDUCTIBLES”?

Deductibles occasionally have a family maximum. IE, if you have five people in your family, once the carrier has withheld your deductible for the third person they may waive the deductible for each family member for that year.
Carriers calculate your benefits then subtract the deductible before paying. They do not take the deductible from the total accumulated treatment fees. Again, they deduct it from what they would pay if you did not have a deductible.
Some plans do not take a deductible for preventive procedures. Some do!

Q 9. FILLING OUT FORMS . . . WILL YOUR OFFICE DO THIS FOR OUR FAMILY? Yes!

This is part of our administrative service and initial claims are submitted as a courtesy at no additional fee. - We have invested in technology to electronically submit claims within 24 hours of your child's visit. Our administrative staff is committed to providing additional information as requested by your carrier within one week of their request, hopefully sooner. If you ever have a question, or want copies of a claim, just call and we will fax it to you without delay.
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Q 10. WILL I EVER NEED TO CONTACT MY CARRIER DIRECTLY? Perhaps!

Carriers generally send checks within 3 to 6 weeks; we encourage you to make a note on your personal calendar in 7 weeks. If you have not received a check, or other form of explanation of benefits, call your carrier. Since you are the insured CUSTOMER, they are much more interested in providing YOU with a service than your “medical or dental staff.” (If you have a balance in our office, we KINDLY REQUEST YOU CLEAR ANY AMOUNT 90 DAYS AFTER TREATMENT regardless of your carriers reason for delay. This could mean your carrier either has denied payment due to ONE OF THOSE LIMITATIONS we spoke of earlier or they are having an internal problem that is delaying payment. Our administrative staff time is needed to manage timely initial claims and carrier requests for additional information . . . We are NOT SET UP for management of over 90 day outstanding balances. We appreciate your cooperation.)
If your carrier denies payment and you think A PERCENT SHOULD HAVE BEEN COVERED, the best action you can take is to call your employers personnel department. They should have the name of a representative who can follow up. (This also keeps the employer aware of how difficult the carrier they have chosen is to do business with. Perhaps you can make a difference?)

Q 11. HOW WILL I KNOW YOUR STAFF IS SENDING CLAIMS?

If you have a balance . . .you will receive a monthly report in the form of a statement that will show your families insurance activity. If you ever have any questions, call us right away.

We aren’t perfect . . . but we try!

If you do not receive payment or an explanation from your carrier denying coverage . . . please call us. We will confirm that your claim was sent. (Of course you can also call your carrier).

Q 12. WILL I EVER RECEIVE A STATEMENT? Generally NO . . . only if your family has an unpaid balance.

If you have DELTA DENTAL OF CALIFORNIA, they will only send benefits to our office. As a convenience to our DELTA FAMILIES, we estimate your percentage and are comfortable waiting up to 6 weeks for your benefits to arrive. We appreciate your estimated percentage at time of service.
Regardless of your coverage (including Delta) WE KINDLY REQUEST YOU CLEAR ANY BALANCE IF YOU RECEIVE A SECOND STATEMENT and we will reimburse you when your delayed benefits finally arrive. (As above, we encourage you to call your personnel department if there is a delay. Something is wrong).

Q 13. WHY DON’T/WON’T CARRIERS RELEASE THE FEE SCHEDULES THEY USE TO ESTABLISH PAYMENT? Great question! . . . Our GUESS is two fold . . .

— Carriers are fully aware of the differences in offices and services, however they continue to “take an average” when establishing a USUAL AND CUSTOMARY FEE BASE. (Frankly, you get what you pay for).

They like to say they use USUAL AND CUSTOMARY FEE SURVEYS BASED ON ZIP CODES . . . They know this is not a reasonable approach to establishing fees because there is such a difference in how medical and dental procedures are provided. Some organizations let cost guide their services . . . WE DO NOT.

We always use the highest quality of products available and we take as much time as needed to provide gentle care.
We promise that every possible precaution is taken to provide a safe treatment environment.
We follow comprehensive OSHA disinfection standards and use maximum safety barriers.
Dr. Adams and Dr. Sam's standard of care dictates that your child has a full time assistant personally trained to supervise your child's entire visit.
They want to change payment schedules as often as they wish. If fee schedules were published, this would make it more difficult to do so.

Q 14. WILL YOU JUST BILL ME AFTER MY INSURANCE PAYS? Very simply, we are not set up for extended billing.

Our focus is on the immediate care and needs of our children. To make sure our everyday service and patient care is to our standard, we are not set up to manage avoidable and lengthy billing. - We understand families generally do not budget for emergency or often even preventive health care so or your support, we offer a variety of ways for you to take care of desired treatment (click for link to SUPPORT SERVICES).

We accept Visa and MasterCard.
We have a financial services company that provides unsecured funds for our families. This allows us to offer affordable monthly payments. Our staff manages all the paper work through our office..
Our Doctors will prioritize treatment so you can be treated over time if none support options are workable in your personal budget. (Please be mindful that delaying care may create an uncomfortable urgent need and potential increased expense).

Q 15. WHY CAN’T I JUST PAY AN ESTIMATED PERCENTAGE SHARE IF I HAVE INDEMNITY COVERAGE? (“I’ve had other dentists to this for me . . . ”)

We have found that when we get overly involved in trying to GUESS what a carrier will pay IF (WHEN) YOUR CARRIER DOESN’T PAY EXACTLY THE ESTIMATED AMOUNT, patients occasionally HOLD US RESPONSIBLE for the difference. — Our goal is to keep our Doctor/patient relationships focused on discovery, recommendations and treatment results . . . not insurance benefit payment. We hope you appreciate our focus and will join us in sharing a healthy and rewarding relationship that will endure over many years.

Our goal is to provide you with the CONFIDENCE we believe

you want to have in every doctor and team member that is part

of your families preventive health care team.

Q 16. DO YOU HAVE A QUESTION WE HAVE NOT ADDRESSED?

PLEASE CONTACT OUR ADMINISTRATIVE INSURANCE STAFF (click for link). They will be happy to speak to you personally or direct you to your employers personnel department if appropriate.